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    Safe And Effective Skeptical Activism - The 10:23 Campaign
    By Josh Witten | October 19th 2010 09:17 AM | 18 comments | Print | E-mail | Track Comments
    About Josh

    Welcome to the home of the rugbyologist. Come along as I wander far and wide (and near, too), stop to smell the roses of intellectual fancy, and...

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    At 10:23AM on 30 January 2010, the 10:23 Campaign staged a mass overdose of homeopathic "medicine" to protest the sale of homeopathy products in Boots pharmacies, especially under the Boots brand name. The event generated a considerable amount of media attention and increased public awareness of the nature of homeopathy, although it has not yet succeeded in getting Boots to disavow homeopathy.

    Spending on homeopathy by the government and private individuals is medically indefensible. Furthermore, wasting money on medically ineffective water and sugar pills at a time when local NHS trusts regularly run out of funds, and education and scientific research budgets may be slashed is ridiculous. Therefore, I am a strong supporter of the 10:23 Campaign's goals and want nothing more[1] than to see them succeed.

    But[3] I have concerns about the safety and efficacy of the 10:23 Campaign's approach, which I have helpfully categorized as Economic, Philosophic, Scientific, Pedagogic, and Safety.

    Economic
    Boots sells homeopathic products because people buy them. If obtaining homeopathic products involves buying them from Boots, then those purchases go down as customer interest in homeopathy. I doubt Boots has a hipster flag for ironic purchases.

    This is not a very important concern.

    Philosophic
    "10:23" is a reference to Avogadro's number, because homeopathic remedies are frequently diluted until the odds of finding even a single molecule of the "therapeutic" compound in solution are astronomical. Thus, the tagline, "There's nothing in it".

    Unfortunately, many homeopaths will agree that there are no molecules remaining in solution. Instead, they suggest that the water "remembers" the compound through some vague hand waving mechanism that invokes "quantum mechanics" and is potentized by succussion.

    "Water memory" is thoroughly implausible, but it is the proposed mechanism for homeopathic action and, therefore, is the hypothesis to address.

    Scientific
    The mass overdose stunt is not a scientific test, but it may provide data that is detrimental to the anti-homeopathy campaign. The stunt's efficacy is predicated upon participants suffering no ill effects after "overdosing" on the homeopathic remedy. The odds of something happening because of the "overdose" are small, the odds that something bad will happen by chance grows as the popularity of the campaign increases. Unfortunately, bad things randomly happen to people, and if one of those things happens close in time to the overdose it may be used as evidence of homeopathic efficacy. The Boobquake protest was similarly undermined by the virtual certainty of a 6+ earthquake occurring within 48 hours of the protest time.

    Pedagogic
    Most people do not believe in the Law of Similars or the Law of Infinitesimals. They think homeopathic remedy means herbal remedy. Therefore, explaining that "there's nothing in it" may seem like a straight forward educational approach. But, as a friend who is a Christian minister[4] says about atheist arguments:
    "I don't believe in that jerk either."

    Homeopaths can say the same about the "there's nothing in it" argument and invoke "water memory". In the same vein, the lack of harm from mass overdose stunts can be presented as a lack of side effects. Remember, homeopathy advocates are not operating from a biochemical understanding of therapeutic action.

    Therefore, it is not clear that mass overdose stunts are the most effective tool for teaching the public about homeopathy. While the "water memory" mechanism cannot be directly refuted in a publicly dramatic way, the implausibility is evident when one sees the preparation of a homeopathic remedy, as demonstrated by Crispian Jago:


    Safety
    The overdose is a staple of homeopath opponents. Homeopathic overdoses appear safe because homeopathic remedies are diluted until they are just water or sugar pills.

    The homeopathic industry, however, is poorly regulated. It is not unknown for so-called "homeopathic" remedies to contain physiologically significant doses of active compounds (e.g., zinc in Zicam). The alternative medicine industry is notorious for the presence of undeclared drug ingredients in their products. A mass overdose of such products could pose a health risk to activists.

    Conclusion
    I do not know what the 10:23 Campaign has planned for 2011, but I would hope that future stunts maximize participant safety. I also hope that they embrace the opportunity to make their stunts more than a way to generate publicity, but also to creatively educate the public in an effective manner.

    NOTES

    1. Technically untrue. I want my kids to be healthy and a tenured faculty position a lot more. It's just a figure of speech. Jesus[2].

    2. Also, just a figure of speech.

    3. Yeah, you knew that one was coming. So clever, that one.

    4. Apologies for any misquoting and for lumping a lovely man in with homeopaths.



    *Front page image by Richard Craig (Creative Commons 2.0 Generic)




    Comments

    Aitch
    As a former activist, I'm aware that publicity is the essential tool of campaigns
    However, there is a possibility as you say, of them backfiring, and driving people towards what is campaigned against

    Examples of this are the little known fact the the 'laws of similars', referred to, are reputed to come from the grandfather of medicines, Hippocrates, although Homeopathy is the invention of Samuel Christian Hahnemann, born in 1755 in Dresden, Germany, and educated as a physician.

    Further, homeopathic remedies are in use by medical practitioners the world over, and by sports professionals, and vets alike

    examples are Rescue Remedy

    http://www.science20.com/news_articles/does_rescue_remedy_work_anxiety_y...

    Further example;
     a 1991 meta-analysis by Linde et al, which considered the evidence from 107 trials, was published in the respected medical journal The Lancet. The authors were surprised by the amount of favourable evidence they found – 81 of the trials had positive results – and concluded: ‘it is wrong to say that homeopathy has not been evaluated according to the modern method of controlled trials’
    Ref: The Lancet 1997; 350:834-43

    Arnica, also, is widely known for its help to rheumatism sufferers,

    http://en.wikipedia.org/wiki/Arnica

    As a sportsman you may be aware of homeopathy in sport - including many qualified references

    http://www.pponline.co.uk/encyc/homeopathy-in-sport.htm

    Homeopathic Veterinary Surgeons

    http://www.bahvs.com/index.html

    ....and the Beth Israel Deaconess Medical Center, holds a database of a double-blind, placebo-controlled trialed substances

    http://www.bidmc.org/YourHealth/TherapeuticCenters/Search/SearchResults/...

    However, in conclusion, they say,
    "Because the theories of homeopathy seem to contradict basic laws of physics, it appears reasonable to insist that homeopathy pass a higher standard of proof than other forms of alternative medicine, and it has not yet done so. As we shall see in subsequent pages, some apparently rigorous studies do appear to have found homeopathic methods effective. However, many more studies have failed to find it effective, and overall, the body of supporting evidence is too weak to overcome the reasonable presumption that it does not work. Proponents of homeopathy have considerable work to do before their method can be given scientific credence."
    Given the same level of proofs as conventional medicines would be a fairer comparison for the medical profession, and more honest and open, but remains unlikely in the near future
    ..... and for the safety of the public, to which you address yourself, admirably

    'New' Regulatory frameworks are already trying to address safety of drugs issued to the public

    http://www.science20.com/newswire/new_safety_regulations_drive_greater_n...

    I have seen an article, but cannot locate it, which hints at commercial pressure to sidestep regulations for profit, if I locate it, I'll add it

    Thanks for the opportunity to 'show the other side'

    Aitch
    Hank
    Rescue Remedy is a 'natural' remedy distilled from flowers, not homeopathy.   People selling homeopathy like to confuse the two and make them synonymous because it legitimizes their witchcraft.    It is clever marketing on the part of the charlatans getting rich off of uneducated people but I am surprised you make the same mistake.

    P.S.  It could also be a total placebo.   'Stress' is so vague there can be no real controlled trial so Rescue Remedy 'working' is interesting but only one company (the one that makes it) funds a study every few years so it's hard to know what it does or, if it does anything, why.
    Aitch
    Yes, Hank...but then so do a fair few scientists...witchcraft isn't a loaded phrase now, is it?

    Aitch
    Hank
    Not when it comes to people practicing it.   Homeopathy is what it is - junkie fake pretensions of science that cost uneducated people money.   I could have said voodoo, I suppose.

    The good news, though, is that because homeopathy is the 'air guitar' of medicine, I never need to read a whole book on it - I can just read the first letter of the first paragraph and get the benefit of reading the whole thing.  :)
    Aitch
    Perhaps the words of 'Oh come all ye faithful', to 'Air on a G string'....

    Remind me to keep away from your bonfires, lest your air guitar fan the flames my way ;-)

    Aitch
    Aitch
    See also double blind placebo tests questioned

    http://www.science20.com/news_articles/if_placebos_are_standards_trials_...

    Aitch
    Hank
    I think you have misread this also.   Many studies do not specifically outline what is the placebo (sugar pill, etc.) so therefore the researcher was making the point that placebos could have physical effects that are unknown - not that placebos are not trusted - but only if the placebo is not actually a placebo.

    Her more bizarre contention, that any placebo, perhaps even a sugar pill, has some wild impact on a drug trial was her speculation and not anything grounded in evidence.  


    Aitch
    No, I didn't misread it...it is connective posting, that's all, since I'd mentioned placebo, and double-blind tests

    Aitch
    Fantastic - have blogged a link over to this article, after writing about 10:23 for the CSICOP site. Thanks so much for thinking through this further, it's much needed! :)

    Good article Josh

    I won't take all your points one by one because I really would be interested in the comments that are made below.

    A couple of things though, as Project Leader for the campaign.

    1 safety

    I'm not sure if you read through the document I sent through to you the last time we discussed 1023, but I hope it was clear that safety was, and is, the number 1 priority. We (meaning the organisers of course, but also the hubs organising the stunt) went to considerable trouble to mitigate risk. For example mandating homeopathic preparations from, ironically, Boots as we felt that was a pretty good way to ensure they were not tainted. The t-shirts were also an important opart of the strategy because they weren't distributed until the day itself. This was a mechanism we deliberately put in to ensure only "known" people were involved, or if they were not known to the organiser they were at least engaged face to face prior to the stunt.

    In communications to the hubs safety was highlighted as a chief concern when dealing with potentially large numbers of people. I think this was understood but if not I would be interested in hearing about it.

    2 I don't think that missing the objective of getting Boots to remove their homeopathy is the end of the world considering the amount of press attention the campaign received. Basically the Boots objective was know to be difficult with significant uncontrollable risk associated with its achievement. The other objectives which you have a copy of were surpassed within only a couple of weeks of the campaign starting. No-one at 10:23 HQ is surprised this objective was missed. IT was a guiding light. A bit of a longshot that generated significant noise to Boots Customer Service, caused them to take down a portion of their website and made them answer for themselves publicly. Although not the direct intention, I also think the Boots aspect contributed to the rallying of skeptics.

    3 "there's nothing in it"

    In my experience, marketing is always a compromise. Skeptics have often been accused of poor skills when it comes to this. In this slogan we came up with 4 words that described the physical properties of homeopathy, and the plausibility of it. It's also catchy.

    I have no regrets in this regard. Nix Drin Nix Dran

    3 In 2011 we have something big planned. Big and global. Partners around the world are preparing their plans as we speak. When we were in Budapest recently I was asked by one group "what's the main consideration when we run our campaign?". "Safety" was my answer.

    Plans will be spelled out soon. We invite all UK skeptics and those around the world to rally together with a very loud voice on the weekend of 5th and 6th February. If you will be at QEDcon that weekend, don't worry. We're up to something. If you are reading this from outside the UK and want to get in touch with your country specific organisers, or wish to be one, get in touch with contact at 1023.org.uk.

    Thanks again for encouraging the debate.

    Cheers

    Andy

    jtwitten
    Dear Andy,

    Thank you for your comments. Hopefully, I did not suggest that The 10:23 Campaign was cavalier about safety. Especially with the expansion to many countries with a wide variety of regulatory systems, it is very important to have everyone involved be aware of the fundamental issues regarding safety and be equipped to take on the personal responsibility for their own safety. The simple fact that homeopathic preparations are poorly regulated by both government and retail should be taken into account. That being said, I do believe that the individual risk (when purchasing from a high profile retailer) from this is quite low.

    I would also agree that getting Boots to swear off homeopathy was a ambitious goal and it is not fair to call the Campaign a "failure" for failing to achieve that objective. It is, however, part of the context of this discussion. For example, I imagine you have had to deal with the question of why The 10:23 Campaign is investing energy in international expansion when they have not succeeded in their local objectives.

    I also appreciate the difficulties of framing a marketing strategy and "There's Nothing In It" is both catchy and accurate, which are strengths. Its weakness is that it is susceptible to the "straw man" argument, which is a weakness that must be considered in the balance from both an effectiveness and an integrity point of view.

    Unfortunately, as enthusiasm and involvement in The 10:23 Campaign grows, these discussions will become progressively more difficult to have.

    Cheers
    When I said "I won't take all your points one by one because I really would be interested in the comments that are made below."

    I was saying that I'm looking forward to other people's comments unfolding. Not that I was looking forward to reading my own, which is true but not what I meant to say.

    :-)

    Andy

    jlparkinson1
    The burden of proof should rest squarely on the homeopaths. Homeopathy is extremely implausible given our current understanding of chemistry&biology. If water truly did have "a memory" as homeopaths claim it does, much of what we know about chemistry and biology would be wrong. That's an extraordinary claim -- and extraordinary claims demand extraordinary evidence. Unless homeopaths can provide that kind of evidence, there's no reason why their products should be covered by the NHS or any other insurance.
    If people want to buy water from homeopaths and call it medicine, that's up to them, of course...it's a free country. But supporting this kind of thing with taxpayer money is another thing altogether.
    jtwitten
    You are correct. Unfortunately, the current state of the world is that these things are currently funded by the NHS and purchased by individuals. Therefore, the standard for a public campaign is not just scientific proof (i.e., the evidence to support your position with integrity), but also presenting your position in a way that effectively changes minds (i.e., teaching people about the implausibility of homeopathy).
    Hi Josh

    Regarding the international expansion, I don't see this as a separate and new thing. There was an international aspect in 2010 and the only question really is "shall we do it again in 2011?"

    We arrived at the answer "yes" to this question. The only material difference is that the international aspect was not focussed upon to an effective degree. We are simply correcting that error this time.

    There is significant support for continuing the 10:23 campaign. The shape will be different this year and probably in each year to come if it is to have longevity.

    Cheers

    Andy

    jtwitten
    As a social campaign, perception is key. The focus on promoting the international aspect creates the perception that this is something new, which raises questions. Questions that, in this case, have reasonable answers within the previous goals of the campaign - for example, British government and businesses appear highly sensitive to international ridicule, such as with libel reform.
    Hank
    I'm interested to see how this goes in 2011 and if it can make an impact in the US, where the homeopaths have quite cleverly used marketing to conflate homeopathy with 'natural remedies', as if not believing that 1 millionth of something in a vial of overpriced water will work is the same as saying a chemical found in nature can't ease a headache.
    jtwitten
    So-called homeopathic remedies also have special rules that effectively exempt them from pre-market oversight by the FDA.